Health Library

As any parent knows, raising kids is not easy. Parents of children with
type 1, or insulin-dependent
diabetes
, face all the usual challenges of child-rearing plus the unique issues that come with their child’s disease. Even the simplest activities, like birthday parties or playing ball, can be stressful if they are not carefully planned.

Children with diabetes need to keep their blood glucose under control to maintain normal growth and development, and a normal lifestyle. While doctors and dietitians provide the specific treatment your child needs, the following tips can help you teach your child how to live with this disease.

Helping Your Child Adjust to Living With Diabetes

Your child will have plenty of questions about their diabetes as they get older. But it’s important to remember that while diabetes is a big part of your child’s life, it’s only one part. Here are some pointers to help you instill both knowledge and a positive attitude in your child, in any stage of their young life.

There will be times when your child has difficulty with the routine of blood tests and injections. Try to anticipate what kind of problems you may encounter based on your child's history. You may be tempted to skip tests or injections when your child is being extremely uncooperative. If you do so, you will be doing more harm than good. It is important to stick with the routine and not get caught up in bargaining. Keep the lines of communication open in order to find out what the real issues behind the behavior are.

Infants and Toddlers

Children under the age of two are too young to understand what’s going on. Stay calm and try to test blood and inject insulin quickly. Comfort and reassure your child afterward.

Preschool Children

Explain diabetes-related terms and what you are doing to treat the disease, simply and often. Make sure your child understands they did not do anything to cause diabetes and the steps you take allow them to control it. Reiterate that controlling diabetes allows them to do what they love doing. This reassurance should be repeated beyond your child's preschool years.

Children 5-12 Years Old

Slowly let your child take on more diabetes-related tasks such as meal planning and doing blood sugar checks, but stay involved. Use your child’s maturity, skills, readiness, and interest to help you determine how much they are ready for and when. Also, answer any questions your child has and make sure they can talk comfortably about the disease. This will help their peers feel comfortable with diabetes too.

Teenagers

The teenage years can be a time of rebellion and experimentation. Puberty brings growth spurts and body changes, making glucose control more difficult. This may lead to poor diabetes management. Teens usually do not consider the consequences of skipping tests and injections. They may not understand or worry about the long-term implications of poor glucose control and the dangers that diabetes carries.

Help your teenager through this time by being honest, sensitive, and supportive. Teach teens the facts about diabetes and how the choices they make will affect them. Get help from teachers or counselors if necessary. Don’t forget, Try to anticipate teenage temptations such as alcohol and give your teenager the tools they need to address these temptations without creating diabetic disasters.

Keep Blood Glucose at a Healthy Level

Glucose is the main type of sugar found in the blood, which is used by the body as the primary source of energy. It is important to keep blood glucose levels at a healthy level—in the range of about 70-120 mg/dl (milligrams per deciliter) [3.9-6.7 mmol/L (millimoles per liter)]. Keeping blood sugar well-controlled is important to prevent and/or slow down disease-related problems.

Parents and children might have difficulty recognizing when blood sugar is low.
Hypoglycemia
(low blood sugar) can cause significant problems for children. Signs of hypoglycemia include:

Trembling, anxiousness, or palpitations

Sweating

Hunger

Confusion or odd behavior

Seizures

Fatigue

Headache

Blurred vision

More serious episodes can lead to coma or death. Be sure that you work with your doctors and diabetes educators to assure that episodes are recognized and treated promptly.

Conversely, moderately high blood glucose levels generally do not cause symptoms. The damage done to the body by moderate elevations in glucose increase slowly over time, creating many serious long-term complications.

Blood Glucose Monitoring

Blood glucose monitoring
is the primary tool used to keep track of blood glucose levels. It is done by taking a drop of blood (usually from the finger) and testing it in a glucose meter. Your child’s pediatrician will tell you when and how often your child should check their blood glucose and what the appropriate range is. Most doctors recommend that blood be tested at different times during the day: sometimes before, and sometimes after a meal.

Insulin

Because children with type 1 diabetes cannot produce insulin on their own, they must receive insulin injections. Most children need no less than two, and sometimes three or more shots of insulin a day. These shots should be spaced appropriately throughout the day and be given at the same time each day. Doctors try to design an insulin schedule for each child that will closely mimic the normal insulin response to meals and snacks. Some children may be able to use an insulin pump, which delivers a continuous, but adjustable, flow of insulin to the body and usually eliminates the need for daily insulin injections.

Because each child is different, there is no strict rule about when children can administer their own insulin injections. By age 14, most children can (but should not be required to) give their own injections. Talk to your child’s doctor about what’s right for them.

In addition to measuring blood glucose and giving insulin, your child should keep a log of the results from their blood glucose tests. This will allow your child’s doctor, dietitian, or nurse to work with you and your child in making any necessary changes in the diabetes management plan.

Diabetes and Diet

People with diabetes have the same nutritional needs as anyone else. Unlike what many people think, children with diabetes can eat just about anything. Children who take insulin, however, do need to determine how much they are going to eat at a given meal. They must also balance their carbohydrate intake with the amount of insulin injected. Diet and insulin requirements may change with factors such as weight, amount of exercise, age, and medical conditions. Your best bet is to develop an eating plan based on your child’s class, lunch, gym, and afternoon activity schedule, and help your child follow it as closely as possible.

In general, to eat right, a child with type 1 diabetes ought to:

Eat a diet that is low in saturated fat and includes a variety of whole grains, low-fat dairy products, and plenty of fruits and vegetables.

Eat about the same amount of food each day. Make adjustments based on the amount of activity or exercise you have planned for the day.

Eat meals and snacks at about the same time each day (without skipping any).

Eat soon after taking insulin, especially if very fast-acting insulin is prescribed.

Be ready for emergencies. Children, their teachers, or the school nurse should have a doctor-recommended treatment for
hypoglycemia readily at hand in case it is needed. In most cases this treatment will be a form of sugar, but in some cases an injectable form of the hormone glucagon might be recommended.

Send your child off with healthful snacks such as fruit or nuts and money in case they needs to buy food.

Learn to read food labels, so they can identify carbohydrates, fats, and other nutrients plus proper serving sizes.

While you don’t need to ban “empty calorie” snacks like cookies and cake or prohibit your child from buying school lunches, you should encourage them to make healthy choices. At times when you know your child will be eating something extra sugary, such as at a party, they may have to take more insulin. Plan ahead for such events. Contact your child’s teacher or parents of friends for help reinforcing healthy eating habits away from home.

Diabetes and Exercise

Taking part in gym class and team sports is especially important for children with diabetes. It not only boosts esteem and improves overall health, but can also help control weight and lower blood sugar levels.

Talk to your child and their doctor or diabetes educator about planning an exercise program. Your doctor will likely recommend a combination of aerobic exercise, stretching, and toning. Be sure your child starts out slowly and then gradually increases the intensity and length of the sessions. Also, teach your child, physical education instructors, and coaches to watch out for signs of hypoglycemia.

To prevent low blood glucose reactions, your child should:

Drink plenty of fluids before, during, and after exercise.

Exercise at about the same time each day. Have your child carry snack foods like pretzels or crackers with cheese or peanut butter in case of unplanned activity.

If your child becomes hypoglycemic, stop exercising and follow your doctor’s advice about what to do in this situation.

Diabetes and School

Once children reach school age it is important that parents make a good connection with the school health nurse so that they can assist with challenges in the school setting. As with any child, it is important for parents to keep in close contact with their child’s teachers to detect and respond to concerns.

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Diabetes. American Academy of Family Physicians Family Doctor website. Available at:
http://familydoctor.org/familydoctor/en/diseases-conditions/diabetes.html. Updated January 2011. Accessed January 21, 2014.

What I need to know about eating and diabetes. National Institute of Diabetes & Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH) website. Available at:
http://diabetes.niddk.nih.gov/dm/pubs/eating%5Fez/index.aspx. Updated September 9, 2013. Accessed January 21, 2014.